As a clinical social worker, you are expected to have some basic knowledge of medical conditions. It is important to be aware of medical disorders that can impact or present as psychological disorders. This comes as a surprise to some of our customers preparing for their ASWB social work exams who often see this as being outside of their scope of practice. While we should never make medical diagnoses or recommendations, we do want to make sure we know when to refer clients back to a physician for further evaluation.
Ruling Out Medical Conditions
Why is it so important to rule out underlying medical conditions before engaging in therapy? Imagine being a client who presents for therapy for depression. This client consistently shows up each week for therapy. They invest their time, money, emotional and mental energy. No matter what they do, though, their depression doesn’t get any better. After months of therapy, they go to their annual physical only to discover they have Type 2 Diabetes. They work with their doctor to manage their new diabetes diagnosis, and their depression symptoms subside.
Best Practice with Medical Conditions
A number of disorders can present with psychological symptoms. Everything from fibromyalgia to diabetes to hypothyroidism to Lyme disease can impact mental health and mood. It is best practice as social workers to refer clients to a medical doctor to rule out any underlying medical condition when new symptoms present. We should make this referral anytime a client presents with new physical, behavioral, or emotional symptoms that haven’t been checked out by a doctor. We want to rule out any underlying biological cause before beginning treatment to avoid treating a physical condition as though it is a mental health condition.
Let's test your knowledge on this topic with a FREE ASWB practice question:
ASWB Practice Question
A social worker meets with a 22-year-old woman who reports she is experiencing increased feelings of anxiety, agitation, and irritability. What should the social worker do NEXT? A. Consider a diagnosis of hyperthyroidism
B. Refer the client for a psychiatric evaluation
C. Complete a biopsychosocial assessment
D. Refer the client for a medical evaluation
(scroll down for answer)
The correct answer is D, to refer the client for a medical evaluation. The client reports increased feelings of anxiety, agitation, and irritability. Before doing anything else, we want to discuss the need for a medical evaluation to rule out a possible underlying medical reason for her condition. While we aren’t expected to know any and every medical condition, we are expected to know that a medical referral for new symptoms is the best practice. A is outside of our scope of practice; it wouldn’t be our job to consider this specific medical diagnosis, but to refer her to someone who can rule out this and any other underlying biological cause for her symptoms. B is incorrect, because while at some point we may make a referral to a psychiatrist for medication, it is not what we would do FIRST. C could occur after we do D.
ASWB Masters and Clinical Exam Preparation
How did you do with this month’s free ASWB practice question? Do you feel confident about approaching medical disorder questions on the exam? TDC offers a quick study on the most common mental disorders that present as mental health conditions. We also offer a number of practice questions showing how this topic may show up on your exam.
If you’re preparing for your ASWB master's exam or clinical level ASWB exams, TDC has programs that will get you ready to pass your exam with CONFIDENCE. Our comprehensive, online courses give you everything you need to be successful on the exam without overwhelming you with unnecessary information that isn’t going to show up on the test. We balance content and reasoning skills and have helped THOUSANDS of social workers successfully pass their licensure exams. The best part? We are with you until you pass your ASWB exams. You never have to pay for an extension and you can email a coach who is a licensed clinical social worker (and has passed their exam with at least a 90%!) anytime questions come up.
I do not agree with this answer. The question does not say she is experiencing new symptoms BUT “increased” as a client being referred to a social worker it’s expected that within the bio psycho social I would review medical
History and either rule out or refer to a pcp.
Can you elaborate?
Hi Jessica, It is okay to disagree with it, but know this is the answer that would be expected by the exam. It can be new symptoms or worsening (increased) symptoms that warrant a need for a medical evaluation. If there's any possibility of an underlying biological cause, we first and foremost want to rule that out.
Is this the case where if an answer is “seek medical care”, that would likely be the answer?
I ask because I also thought answer C?
Only if it fits the presenting issue. If a client wasn't presenting with new emotional, behavioral, or physical symptoms that could have an underlying medical cause, then that referral wouldn't make sense. Or you could have a situation where there are physical symptoms present, but there is something more pressing (like an immediate safety issue), in which case that would need to be addressed first.
Hi there, I also chose C and am feeling confused about the explanation. If this is an initial encounter an assessment does seem like the logical first step. If it’s not the initial encounter there wasn’t enough information in the question for me to feel comfortable choosing med eval so I chose C because I would reassess my pt before sending her for a med eval. I work in a hospital and if I sent every patient that had increasing symptoms of anxiety for a med eval I don’t think I’d last very long in my job lol.
For purposes of the exam, if a client presents with any symptoms that could have an underlying biological cause, the expected answer is to make a referral. After that we can move into doing the assessment. But what the ASWB is assessing here is that we know first and foremost when a client has new physical, emotional, or biological symptoms that could have an underlying biological cause, we need to first and foremost refer them for a physical/medical evaluation. It's not our job to reassess before sending her for a medical evaluation. We aren't doctors. If there are symptoms that <em>could even possibly</em> have an underlying biological cause, we should make a referral to have them checked out. It doesn't mean we aren't continuing to meet with them, but best practice with a new client with physical, emotional, or behavioral symptoms is to ensure they've had a recent physical to rule out something biological. Lots of physical health issues can present as depression, anxiety, irritability, etc. Even if this isn't something you choose to do in your own work, it is the expected best practice for the exam.
I totally agree with you but what I have learned is that this test is not the real world. It's a hustle that the boards have created that we have to pass. There are many questions like this that make no sense at all! They have created an entire cottage industry around this test. And if you and I want to pass it then we have to play the game. Once we get in then we can try to change it.
The expected answers certainly can vary from what expectations of our employers are (I came across this a lot around school social work questions when I was preparing for my exam and working in a school). There certainly is space to advocate for change.